To repeal the Prevention and Public Health Fund.

Mr. Speaker, what we are going to do here for the next hour is talk about why we feel so strongly the need to repeal, and if not successful, to defund so many provisions of the Patient Protection and Affordable Care Act.

But, Mr. Speaker, before I get started in the subject at hand, I do want to join my colleagues, particularly my colleagues on the Democratic side of the aisle, in remembering our colleague John Adler. I didn't realize that John had been sick. I didn't realize that John had had surgery. I didn't realize until just moments ago that our colleague from New Jersey had died. As I sat here listening to the New Jersey delegation on both sides of the aisle talk about John, it helped me understand a little bit better about him.

All I know about John is that he was a great guy and a really, really nice Member of this body and someone that I respected. I got to know him, Mr. Speaker, in the House gym at 6 o'clock in the morning usually. He would be working out, and I would be working out--I am 15 years older than John was--and we just struck up a good friendship. I truly will miss him, as well as my other colleagues, as they express their sympathy to his wife and his four sons. But truly a great Member.

It reminds me too, Mr. Speaker, that as we do our work, as we do our work with 1-minutes, and we do our work with 5-minute Special Orders, and now this leadership hour talking about a very important issue that our colleagues on the other side of the aisle for the most part, almost 100 percent of them feel very differently about this issue, we differ on a lot of things, and we will continue to do that. It has gone on forever.

But the point I would like to make, and I will conclude with this, is that there are 435 people in this House of Representatives. And sometimes we Republicans are in the majority and sometimes the Democrats are in the majority, and the worm turns, and nothing is forever.

But we have good, decent men and women serving here representing their districts and doing the work of the people. And God bless them. God bless each and every one of them. God bless a Member like John Adler, who died much too young, as my colleagues have said already.

But we want to always keep in mind that as we argue and debate and make points and feel very strongly about an issue, that doesn't mean we don't love one another. And we do. And I loved John Adler. He was a great Member of this body.

Mr. Speaker, again here we are, though, getting right back into the business at hand. And this is a hugely important week, a hugely important week as we try to come to some conclusion in regard to how much money we need to cut out of, not this fiscal year we are in right now, but the last fiscal year, which started--well, actually we are in the fiscal year, but it started on October 1 of 2010.

Here we are, what is it, the 4th of April, 2011, so half of the fiscal year has already expired and we have not funded the government except in this piecemeal fashion.

We didn't have a budget, we didn't have spending bills, and we put these little 2-week Band-Aids, 2, 3 weeks, a little bit of cutting, but from my perspective and from my side of the aisle and our leadership not nearly, nearly enough. And we are faced with this tremendous issue of trying to reach a compromise and an agreement to lower spending.

The American people certainly gave a mandate, I think, to 87 new Republicans and 9 new Democrats to come up here and quit all this spending. Let's not have $1.5 trillion deficits year after year after year. That's how you get to $14 trillion worth of debt, and that's what we are facing right now; and, indeed, in a month or so, we are going to be asked to even raise that debt ceiling statutorily to say, well, we will continue to borrow and kick the can down the road.

Obviously, Mr. Speaker, these are times that try men and women's souls, and we all feel very strongly about our position. But I know my leadership and Members on this side of the aisle, and I hope our Democrat colleagues, feel the same way. We hope and pray that we can do the people's work and cut this spending and get this country back on a sound fiscal footing so that as we go forward to the 2012 budget, which we will hear about tomorrow, that we will continue to work hard to finally balance this budget and get our country out of this significant debt.

Speaking of debt, Mr. Speaker, the reason I am here tonight, I represent the caucus on the Republican side of the aisle known as the House GOP Doctors Caucus. There are, I think, 21 of us now, doctors and nurses on this side of the aisle, with just years and years of clinical experience.

As an example, I spent 26 years practicing my specialty of obstetrics and gynecology. We have registered nurses that are part of the Doctors Caucus. We have specialists, general surgeons, cardiothoracic surgeons, family practitioners, gastroenterologists. I could go on and on, but some of them, hopefully, will be with me during this hour, will join me in a few minutes to talk a little bit more about our concerns, their concerns, Mr. Speaker, with the Patient Protection and Affordable Care Act of 2010.

This was a bill, a law, that was finally passed and signed by President Obama on March 23, 2010, after about a year and a half of debating the issue in both this Chamber and in the Senate Chamber; and when it finally came down to the reality that there weren't enough votes on the Senate side, it was passed by something called reconciliation which, to this day, I don't think the American people understand. But, Mr. Speaker, I will tell you this, what they do understand is they don't like it, they didn't like the process, and they don't like the policy.

Now, I have heard the President say, and I have heard the Democratic leadership in the 111th Congress, when this bill was passed, talk about how Congress and particularly the Democratic Members have been trying to pass a comprehensive massive health care reform law for almost 100 years. They talked about Franklin Delano Roosevelt, and they talked about John Fitzgerald Kennedy and they talked about, of course, President Bill Clinton and saying, you know, we finally got there, we finally did it, we finally accomplished what we were trying to do for almost 100 years.

Well, they missed the point, Mr. Speaker, because the reason why that type of legislation was not passed in 100 years is because the American people back then didn't want it anymore than they do today; and some 62 percent still say, very loudly and very clearly, in poll after poll after poll, we don't want the Federal Government taking over health care, one-sixth of our economy, lock, stock and barrel. We don't want that.

We want improvement in our health care; and no matter how good something might be, there is always room for improvement and, clearly, our health care system is too expensive. We agree with that. I think Members on both sides of the aisle can reach that conclusion pretty clearly.

So there is agreement to try to do everything we can to continue to provide the best health care in the world. It's not true when people say our health care system is like that of a Third World country. Nothing could be further from the truth. We have the greatest health care system in the world, and some of the doctors in the House GOP caucus will be with me tonight to talk about that.

You know the old expression, don't throw the baby out with the bath water, I think that's what we have tended to do here. We have enacted into law--on March 23 of last year, it's already had its 1-year anniversary a couple of weeks ago--we have done something that I think is not only opposed to what the American people want, you should never do that, but it's bad, it's bad medicine.

It's bad for consumers, it's bad for patients, it's certainly bad for corporate America. And it's absolutely bad for the taxpayer. It's a top-down sort of system where a bureaucracy comes between literally and figuratively a doctor and his or her patient. That's not a prescription for improving our health care system.

I have got a couple of posters here with me, and I wanted to reference these to my colleagues. In fact, I will have several more, but I am going to keep this one up on my far left, that one that shows the picture, I forget what his name is. Maybe one of my colleagues will remember.

Well, I remember Boss Hogg, but I was trying to remember what the actor's name is; I don't think he is still living. But I think most of my colleagues do remember Boss Hogg from that old series ``The Dukes of Hazzard.'' It was one of my favorites, kind of like poking fun at ourselves, really; sort of like Archie Bunker and ``All in the Family'' and things like that that those of us who have been around awhile can look back on and laugh and get a chuckle out of it.

But Boss Hogg sort of represents the boss, the bureaucracy, if you will, of the government, Big Government, running health care. Under old Boss Hogg's picture, there he is with that cigar in his hand: you can have whatever you like as long as the boss approves it.

And that's really the way it has turned out, what we talked about in the House. I think it was H.R., House of Representatives, bill No. 3200. It was Senate bill 3590 or H.R. 3590, a shell bill that came over from the Senate and finally was passed into law and became known as the Patient Protection and Affordable Care Act.

But that law has so much bureaucracy, and I will get into some of the numbers on that in regard to all of the new folks in the government that would control health care, but all under this giant government takeover, and Boss Hogg sort of represents that to me as a way of communicating with the public.

But in any regard, before I continue with some of the statistics on the bill, I see that I am joined by my colleague from Georgia, a fellow physician and a member of the House GOP Doctors Caucus, who is a family practice physician from the Athens area where the great University of Georgia is located. Dr. Paul Broun is actually a doctor who makes house calls, which is really unique and refreshing. He has been a welcome addition to not only our Georgia delegation but this body.

I yield to the gentleman from Athens and Augusta and my hometown, Dr. Paul Broun.

Mr. Speaker, I thank the gentleman for his contribution and for being with us this evening. I realize there are conflicting things going on on Capitol Hill this

evening, very important things. But I really appreciate Dr. Broun being with us.

We have also been joined by another member of the Doctors Caucus, that is our good friend and new Member, freshman Member from the great, great State of New York, where my daughter and son-in-law reside. Ann Marie Buerkle is a registered nurse, Mr. Speaker, by profession and certainly knows of what she speaks in regard to health care, representing the Angels of Mercy, if you will.

She is concerned, Mr. Speaker, about the health insurance industry and the complexity of such, and maybe even wants to discuss some ways that we could change and improve, certainly improvement is called for, and it doesn't have to be within a 2,400-page bill, as Dr. Broun was mentioning ObamaCare entails.

So at this time, I'm proud to yield to Representative Ann Marie Buerkle.

Mr. Speaker, I thank the gentlewoman from New York for sharing her thoughts. Certainly, I agree completely with her. She clearly knows of what she speaks.

This law, it is no longer a bill, it is now the law. Patient Protection Affordable Care Act, it has been the law for a little more than a year, as I said earlier. Of course, the Congressional Budget Office that estimates the cost of laws that we put into effect, they give us an estimate when it is in the bill form so Members can decide whether or not what we are about to do is something that is affordable. And the estimate of this law costing $900 billion, Mr. Speaker, the true cost over the next 20 years is probably in the neighborhood of $3 trillion, not $900 billion.

But I do want to just talk about that number and remind my colleagues

about the pay-for provision that the Democratic Party, the former majority party in the 111th Congress, had in place at the time this bill was passed. Everything had to be paid for, so you had to figure out a way to come up with the money.

In passing this bill and paying for it, Mr. Speaker, some $570 billion was taken out of the current Medicare program. The Medicare program, which serves something like 47 million of our seniors, 5 or 6 million of them are younger people who are on disability that are covered under Medicare. And we literally, to help pay for this new entitlement, this new entitlement which has very little to do with Medicare except that half of the money, half of the pay-for in this $900 billion was taken from a program, Medicare, servicing our disabled and our elderly, providing them health care, half of the money was taken out of that system. The actuaries and the Medicare trustees tell us that over the next 75 years, the unfunded liability, Mr. Speaker, of Medicare is something like $35 trillion, with a ``t,'' $35 trillion. And yet we took the money by cutting Medicare Advantage something like $120 billion. We cut money out of hospice. We cut money out of long- term care, skilled nursing homes.

We cut money out of home health care. We taxed everything that even looked like it had anything to do with health care: durable medical equipment, supplying oxygen for people who were and are continuing to struggle from chronic obstructive pulmonary disease. ``Emphysema'' is a term we use a lot, and I think most people would recognize that.

Finally, we came up and said, okay, we've paid for this; but at the same time, Mr. Speaker, we did absolutely nothing in regard to medical liability reform, something that probably if we enacted it--and if there were something in this bill, ObamaCare, as the President did promise that there would be--could save $200 billion a year, according to the RAND Corporation and other think tanks, from the overall cost of health care, which is one-sixth of our entire economy, of our gross domestic product in a year. That's how big this industry is. So there is essentially nothing in the bill about medical liability reform.

Why do I say that, Mr. Speaker?

My colleagues, I think you understand that it's not about the high insurance premiums that doctors have to pay on an annual basis so that they can practice and be protected from liability if something goes wrong. Obviously, they need that protection and those health insurance premiums for the high-risk specialties like the one that I enjoyed for 26 years, OB/GYN, and neurosurgery.

Mr. Speaker, think about that doctor at the Tucson Medical Center who was there in that emergency room when our colleague, Representative Gabrielle Giffords, was taken there literally near death. I think Dr. Rhee was his name, R-H-E-E. In fact, Dr. Rhee, I learned later, was a graduate of the great school that I went to, Georgia Tech, the Georgia Institute of Technology. Dr. Rhee spent his career in the military after completing medical school. He served his country for something like 22, 23 years, and he happened to be in that emergency room as head of the trauma center and had had all that specialty training and all those years of treating our wounded warriors in many conflicts--I'm sure in Afghanistan and Iraq.

If he had not been there for our colleague Gabrielle Giffords--God bless her--we would be talking about her today as we were talking earlier about John Adler, our former colleague from the great State of New Jersey who died today. But that doctor was there. He was there.

I fear, as I talk about this new health care law, there is hardly any provision in there that would provide for doctors, even for primary care physicians. There is some attempt, but when you take all the additional Medicaid-eligible patients, increasing the minimum eligibility at 138 percent of the Federal poverty level, you add just millions of additional patients to be seen and literally hundreds of billions of dollars of additional cost onto the backs of our States that have to have balanced budgets, unlike here in the Federal Government where we just keep borrowing money and where we're now up to $14 trillion worth of debt.

So we have a huge problem in regard to this law that the CBO says costs $900 billion over 10 years. I say--and this poster points it out--the true cost, which is the last bullet point with the red dot, is $2.2 trillion and counting; but as Ms. Pelosi said--and I quote her in the third bullet point here--``we have to pass the bill to find out what's in it.'' That was before the bill passed. Clearly, we are finding out now, unfortunately, what the true cost is.

Mr. Speaker, I want to yield additional time to my colleague from New York.

Mr. Speaker, the gentlewoman is absolutely right.

As I pointed out in that $500 billion-plus cut-out of the Medicare program to help pay for this new entitlement of the Patient Protection and Affordable Care Act, $120 billion of the $500 billion-plus was taken from the Medicare Advantage program. The Medicare Advantage program enrolls about 20 to 25 percent of our Medicare beneficiaries.

Why so many?

We are talking about, maybe, 11 million or 12 million who sign up and decide that, rather than the traditional fee-for-service and just pick a doctor out of the Yellow Pages who accepts Medicare, it's more like a health maintenance organization that emphasizes wellness, that emphasizes prevention, tests that are not typically covered under traditional fee-for-service Medicare, like colon cancer screening, breast cancer screening, mammograms for women, especially between the ages of 40 and 60, prostate cancer screening for men, annual physical examinations, follow-ups from a nurse practitioner within the doctor's office, maybe even on a monthly basis to make sure that the senior is taking the medication that was prescribed by the primary care doctor.

All of these things are included with Medicare Advantage. That's why it's called Medicare Advantage. It is an advantage with very little additional cost. In fact, people who are under those programs typically don't have to buy supplemental insurance to cover co-pays and deductibles and hospital care after they've exhausted their benefits. So that's why so many choose that.

Yet what we have done is we've stripped--we've gutted--that program so badly that, of those 12 million, it's estimated 7 million of them will lose that coverage under Medicare Advantage. They'll have to get it under the traditional Medicare, and they'll have to pay $130 a month extra for that supplemental whether they get it through a plan that's endorsed by the American Association of Retired Persons or through some health insurance company, but the average cost is going to be an additional $130 a month for those folks.

So as we talk about the cost, I do want to shift, Mr. Speaker, to the cost

to employers. In this next slide, where the title says, ``ObamaCare Hurts Workers, Increases Costs,'' the majority of employers anticipate health care reform will increase health costs. And most say they plan to pass the increases on to their employees--88 percent plan to do that--or reduce health benefits and programs, 74 percent.

This idea of setting up these exchanges throughout the 50 States and territories and that only 6 million people who have employer-provided health insurance can keep it, they won't need to be on the exchanges, Mr. Speaker, that is absolute poppycock. It's probably going to end up being about 130 million people who get their health care provided today by their employer will end up in those exchanges. And that's why I say this cost that was estimated by the CBO of $900 billion will be in the trillions, because when all of these people morph out of the employer- provided health care onto these exchanges, think how many of them will be eligible for a Federal subsidy to help them pay for that insurance. Because the law says, the so-called ``Affordable Care Act,'' that anybody with an income of less than 400 percent--not 100 percent, not 200 percent, not 300--400 percent of the Federal poverty level--which is getting close to $90,000 for a family of four--I think of my four children and their families of two and three and four, and I know what their incomes are--the Federal Government will be subsidizing so many people that the cost, the true cost will be astronomical, and it is something that we cannot afford. That's why our representative from New York and our other representative from Georgia spoke earlier about we can't do this, we can't afford to do this. We need to repeal this law. It is a bad law.

I've said before, Mr. Speaker, that in my humble opinion I think it's the worst law that has ever been passed in this Congress. There have been some folks on the other side of the aisle--well, not on the other side of the aisle, but the more liberal media who took me to task for saying that, but I truly believe it. I truly believe it's one of the worst laws that was ever passed. And we have made every effort to repeal it.

One of the first things we did in the 112th Congress was pass H.R. 2 to repeal ObamaCare. We sent it over to the Senate, and the Senate-- which is controlled by the Democratic majority and led by the Senator from Nevada, Harry Reid--just simply, I guess, put that in file 13, and H.R. 2 is sort of dead in the water over on the Senate side.

So what we are doing now, it is our obligation because of what the American people have told us: Over 60 percent of them a year after passage of the bill, despite the fact that Ms. Pelosi said, once we pass it and you find out what's in it, you'll like it. No, they don't. They don't like it. They don't like it one darn bit better, and they wanted us to repeal. We made every effort at repeal.

And now we're into Plan B, Mr. Speaker. Plan B, of course, is to try to defund especially the parts of the bill that are on automatic pilot, that we have no control over. And when I say ``we,'' I don't mean the new Republican majority in the House of Representatives; I mean every Member of Congress--100 Senators, 435 Members of the House, both sides of the aisle. For goodness sakes, we ought to have control over the spending.

This is not a poster. I don't have a poster on this one. But tomorrow, in the Energy and Commerce Committee, Mr. Speaker, the committee on which I am proud to serve, along with several of our other House GOP doctor members, we are going to have a markup on several bills to change this automatic pilot spending under ObamaCare and put it into the more typical discretionary spending where Members of Congress can say, do we want to spend that money? And if we do want to spend the money, how much do we want to spend? And that we have oversight and we can make sure every year that we look at the program, and if it's not working then defund it.

And these bills--and I'll just mention them real quickly--H.R. 1217, a bill to repeal the prevention and public health fund, $17.5 billion that the Secretary of Health and Human Services has control over, a fund of money that she can spend in any way she wants to. You think back to the ads that we saw with Andy Griffith as the pitchman on television last year about the great value of this new law and how it's going to strengthen and improve Medicare. How you do that by cutting $500 billion out of a program is beyond me. But that money, that $17.5 billion in this prevention and public health fund, can be spent indiscriminately by a decision made by whoever the Secretary of Health and Human Services might be. H.R. 1216, H.R. 1215, H.R. 1214 and H.R. 1213, in the aggregate, this is over $18 billion worth of spending that we Members of Congress have no control over. We're going to get control over it, though, and we're going to defund anywhere we feel that it is wasted, duplicative spending that the American people can ill afford.

I want to go ahead and point out a few other things that are on the slides, Mr. Speaker. I mentioned, of course, the $575 billion in cuts from the Medicare program. I mentioned the 7.4 million people who will lose that coverage under Medicare Advantage because of that $126 billion pay-for. I didn't mention, though, on this slide the third bullet point.

Many physicians may stop taking Medicare patients because reimbursements will be below the cost of providing the care. Now, is that Representative Phil Gingrey from the 11th of Georgia, is that a statement that I've made? Well, maybe I have made it. But I'm quoting the Actuary of Medicare, Richard Foster, who we had last week as a witness before the Energy and Commerce Committee talking about some of these things. This bears repeating, Mr. Speaker; ``Many physicians may stop taking Medicare patients because reimbursements will be below the cost of providing the care'' Richard Foster, Committee on Medicare and Medicaid Services, Chief Actuary.

Today, doctors are reimbursed under the Medicare program by a formula, an arcane, very difficult--you talk about calculus being difficult; understanding the sustainable growth rate formula to determine how doctors are reimbursed for providing their service, whether it's their brain power or their surgical skills, is beyond anybody's comprehension. And every year, for the last 6 or 7 years, when you apply that formula to the next year's reimbursement level, there is a cut from the last year's reimbursement--2 percent, 3 percent, 4 percent--to the point now, Mr. Speaker, what we have done, of course, we here in the Congress have mitigated those cuts and said we're not going to enact those cuts because these doctors will not be able to provide the care, just as Mr. Foster, the Actuary, said. And if we don't put a bandaid on these cuts and mitigate them, then the doctors will just drop out of the program. And I don't care how much you expand access and hand out more insurance cards, if there are no doctors there to see you, you're not going to have care. You do not have decent care--you don't have any care.

So in this bill, in this new law, not only is that formula still there, and the doctors are facing a 31-percent cut in their reimbursement if we don't mitigate it once again come December 31 of this year, not only is that on their backs, but in ObamaCare, there's this new provision called IPAB, this new bureaucracy--Independent Payment Advisory Board--that's going to actually cut the doctors even more. The Actuary is right: We're not going to have doctors providing the care.

And that's because we've taken money out of this program and put it into an entirely new entitlement program for the most part for young people. Some entitlement, when you force them to buy health insurance in many instances when they don't need it and they don't want it.

Mr. Speaker, I see we've been joined by the cochairman, along with myself, the cochairman of the House GOP Doctors Caucus, my classmate from the 108th Congress, the Member from Pennsylvania, my friend and colleague, Dr. Tim Murphy.

I yield to the gentleman from Pennsylvania.

I want to thank you, Dr. Murphy, and I appreciate you coming.

Mr. Speaker, I thank you for the time. I know our time is up.

I just refer to our last poster in conclusion: Repeal and Replace ObamaCare.

Madam Speaker, by direction of the Committee on Rules, I call up House Resolution 219 and ask for its immediate consideration.

Madam Speaker, for the purpose of debate only, I yield the customary 30 minutes to the gentleman from Florida (Mr. Hastings), pending which I yield myself such time as I may consume. During consideration of this resolution, all time yielded is for the purpose of debate only.

General Leave

Madam Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks.

Madam Speaker, House Resolution 219 provides for a structured rule providing for consideration of H.R. 1217, which repeals the Prevention and Public Health Fund and rescinds any unobligated funds.

Republicans are on the floor today to fulfill part of our Pledge to America that we would cut spending and we would repeal the Democrats' health care bill passed a year ago. On January 19, this House passed H.R. 2 to repeal ObamaCare completely. The ruling liberal Democrats in the Senate, however, have so far refused to consider H.R. 2, but House Republicans remain undeterred. We will repeal ObamaCare piece by piece if that is what it takes.

Because the liberal elites knew their government takeover of health care was unpopular and would likely have consequences at the ballot box, they included $105 billion in mandatory taxpayer spending in the law itself to protect their favorite programs.

Let me take a moment to explain the difference between ``discretionary'' and ``mandatory'' government spending

First, it's important to remember that the Federal Government does not have any money of its own, as it has only what it takes in taxes from hardworking Americans or money that it borrows from foreign creditors and our future generations. We are currently borrowing 43 cents of every dollar that the Federal Government spends.

Discretionary spending is appropriated by Congress annually and therefore subject to congressional oversight and review. Discretionary spending allows Congress to be wise stewards of the taxpayers' money by not funding ineffective or duplicative programs. However, what is called mandatory spending funds programs for people who meet certain criteria and occurs irrespective of congressional appropriations and must be spent whether we have the money or not.

The most recognized mandatory spending programs are Medicare, Medicaid, and Social Security, which operate on autopilot and have not been subject to congressional oversight from year-to-year as funds automatically stream from the Treasury to anyone who qualifies, that is, meets the criteria for a particular benefit.

The bill before us today, H.R. 1217, would repeal a portion of mandatory ObamaCare spending and eliminate a slush fund established for Health and Human Services Secretary Kathleen Sebelius. This slush fund, known as the Prevention and Public Health Fund, will automatically receive $1 billion when fiscal year 2012 begins in October of this year with automatic increases every year until it reaches $2 billion annually in fiscal year 2015.

However, there's a very important distinction between this funding and that for Medicare and Social Security in that this funding does not state eligibility criteria.

The liberal elites in Washington think they know how to spend the taxpayers' money better than individual taxpayers and gives Secretary Sebelius $2 billion a year until Congress acts to repeal her authority to spend without accountability.

Republicans are rejecting this slush fund by considering this bill which would repeal the fund and take back any money that has not already been spent this year. The slush fund is not subject to the annual appropriations process and therefore would not be subject to yearly congressional oversight.

The money will be made available to the Secretary regardless of how she chooses to spend it and whether or not the programs being funded are actually effective.

Again, this is not like Medicare and Social Security. There are no criteria for the spending of this money.

It's important to point out that this bill does not cut any specific program, because the slush fund is used by the Secretary to increase spending above congressionally appropriated levels for whatever program the Secretary chooses.

My colleagues across the aisle will argue that this money is being used to train primary care physicians, to prevent obesity, and to encourage healthy lifestyles. What they won't tell you is that they have absolutely no idea how the money is being used, because they abdicated the authority of Congress to an unelected bureaucrat.

The simple truth is that the money is just as likely to be spent on elective abortion as it is for any other purpose.

In the Democrats' dissenting views from the House Energy and Commerce Committee report, they say without mandatory spending for this slush fund, the programs will not be adequately funded. Well, Madam Speaker, that's what the whole process for appropriations is all about. If the programs need more money, it's up to them to come and justify that.

However, they sang a different tune when liberal House Democrats rammed through a government takeover of health care in November of 2009. They created this slush fund but made it subject to the regular appropriations process. That meant it was subject to yearly congressional oversight and direction for how the money would be spent.

But when the ruling liberal Democrats in the Senate sent over their version of the health care bill, which became law, the slush fund had been made mandatory. The liberal elites claim they put in a safeguard because part of the section creating this slush fund states that Congress has the authority to direct how this funding is spent. Well, as any high school junior civics student could tell you, Congress always has the authority to direct, redirect, repeal, or increase funding. Congress can always pass a new law to change the direction of any funding stream. That's our job as legislators. The need to state explicitly that we have the authority to direct spending in a slush fund is pointless.

The simple truth is that we have a spending crisis in this town in large part due to mandatory spending that operates on autopilot. Instead of working to address our unsustainable spending habits, the ruling Democrats refused even to offer a budget resolution last year or pass a single appropriations bill. The liberal elites failed to lead despite having unchecked control of all levers of power in Washington.

I brought a chart with me today to help illustrate the fact that mandatory spending is out of control in Washington. Madam Speaker, let me show you that because of mandatory spending being on autopilot, by the year 2050 the mandatory spending will absorb all revenue coming into the Federal Government, all tax revenue coming into the Federal Government. That simply is unsustainable. We cannot operate our country when we let three programs take up all of the money that comes into the Federal Government. Something has to be done. And yet the Democrats want to add another program to this, which would speed up this process. We don't need that.

As Washington liberals ignored the growing autopilot spending crisis, adding more unaccountable mandatory spending in the hands of unelected bureaucrats, House Republicans are now working hard to protect the future for our children and grandchildren by restoring congressional oversight of spending.

Now, I am sure many Americans are wondering how a slush fund with a clever title would be spent and why it must be put on autopilot. Let me give you an example. Pitt County, in my home State of North Carolina, received funding from this fund to fix prices at convenience stores so that healthy foods would be less expensive and, therefore, supposedly more attractive to the consumer. In addition, the Pitt County Health Department now plans to use some of this money to put up signs indicating the location of public parks, bike lanes, and alternate transportation.

Although I am certainly not opposed to parks or healthy eating habits, it seems quite clear that the Founders of this country did not intend the Federal Department of Health and Human Services in Washington, DC, to use taxpayer money to subsidize granola bars or purchase signs for bike lanes or parks.

The Federal Government has no business paying for local and community initiatives such as these, especially when we are borrowing 43 cents of every dollar the Federal Government spends to pay for it. The new House Republican majority is ready to lead this country out of our debt crisis. And it starts with voting for this rule and the underlying bill, which will save taxpayers $16 billion.

With that, Madam Speaker, I reserve the balance of my time.

I would just like to point out one small thing to my colleague from Florida. Yes, I do begin wondering every day wondering how I can make life better for other people. But I want to say that there is no accountability whatsoever in this provision of the bill, and we want accountability for every penny of money that we are spending on behalf of the American taxpayers.

Madam Speaker, I yield such time as she may consume to the gentlewoman from North Carolina (Mrs. Ellmers).

I yield myself such time as I may consume.

Mr. Speaker, we are here today to save taxpayers money by cutting wasteful government spending. The program that we are cutting out we cannot be sure does anything for preventative health care. It has designated that, but there is no idea as to where the money is going to be spent. Republicans certainly want to see Americans do a better job of preventing disease and of making their

health care better, but what we fear is that this money may be used for elective abortions, so we are also here today to speak for those who cannot speak for themselves.

This slush fund directs the Secretary of Health and Human Services to invest in prevention and primary care by funding programs and initiatives under the Public Health Services Act. Title X of the Public Health Services Act provides funding for the abortion industry, including organizations like Planned Parenthood, which is the largest abortion provider in the country.

Mr. Speaker, my colleagues across the aisle and the liberals in Washington have really outdone themselves to ensure their favorite constituencies are provided for in their new health care law. This slush fund is yet another Democrat trick to use taxpayer money to subsidize elective abortion. Despite what they may have you believe, supporters of taxpayer-funded elective abortion cannot honestly claim this money cannot be used for elective abortion under Title X. The liberal Democrat elites relinquished all authority over this slush fund to Secretary Sebelius. For far too long, abortion providers have used Title X money to subsidize their operating costs, thereby subsidizing elective abortion.

We've heard a lot of misinformation being circulated in Washington this week about Planned Parenthood, the largest elective abortion provider in the country. As I pointed out in the Rules Committee last night, one of my colleagues across the aisle said that Republicans were ``here to kill women'' and compared us to Nazis.

Liberal Democrats maintain that women will lose access to preventative care if the government stops funding for the abortion industry. What they are not telling you is that Planned Parenthood has almost $1 billion in net assets and reported $737 million in revenues for its most recent filing year. Any big abortion organization making $737 million a year should be able to function without taxpayer subsidies, Mr. Speaker. This is not about women's health or access to preventative care. Through Federal and State Medicaid programs, low- income women have access to family planning and preventative health services at hospitals, doctors' offices and community health centers nationwide.

Another claim Planned Parenthood makes is that 97 percent of the 3 million patients they served in fiscal 2008 received preventative care services and that only 3 percent received abortions. These supporters of taxpayer-funded abortion ought to check their math. According to their own facts sheet for March 2011, Planned Parenthood clinics performed 332,278 abortions in fiscal year 2008. If they saw 3 million patients and performed 332,278 abortions, that means at least 11 percent of the services provided were abortions.

If they cannot be trusted regarding this simple math, what else are they hiding from the American people, Mr. Speaker?

Another astounding statistic I would like to share is that 97.6 percent of pregnant women who received services at Planned Parenthood clinics received abortions. Only 2.4 percent of pregnant women received only prenatal or adoption referral services at Planned Parenthood.

Elective abortion is not health care, Mr. Speaker. This is not about preventative health care or about improving access to primary care. This is about subsidizing the big abortion industry. If this slush fund remains unchecked, the Secretary could fund whatever program she chooses to the tune of up to $2 billion a year. That kind of money can purchase a lot of elective abortions, which strikes at the consciences of so many tax-paying Americans.

Again, I urge my colleagues to vote in favor of this rule and the underlying bill.

I reserve the balance of my time.

Mr. Speaker, I feel I have to respond somewhat to my colleague from Florida on some of the points that he made.

He said that it is the law of the land that no Federal Government money

can be used to fund abortions. I know my colleague from Florida has been here a lot longer than I have been, and I know that he understands the difference between discretionary spending and mandatory spending, and I know that he knows that the Hyde amendment is only on appropriations bills. And as I explained earlier, Mr. Speaker, the appropriations bills are what we call discretionary spending, and that what the Democrats did in the health care bill was to put this $2 billion in that bill and call it mandatory spending, which is not subject to the annual appropriations process and therefore does not have the restriction of the Hyde amendment to apply to it.

So I would like to ask my colleague from Florida if he can guarantee on his own word to the American people today that nothing from this $2 billion that is put in for mandatory spending--it's on automatic pilot--would ever be spent for abortions.

Would the gentleman answer that question?

I yield to the gentleman from Florida.

Can the gentleman guarantee that?

I would like to reclaim my time, Mr. Speaker.

The gentleman has just made my point. He cannot guarantee that this money will not be used for abortions, and neither can anyone else. And that is the point that we are making, Mr. Speaker. There is no accountability for this $2 billion. It is a slush fund for the Secretary of Health and Human Services. And it is wrong, Mr. Speaker, for us to take the hard-earned money of American taxpayers and give it to the Secretary with no accountability and with the distinct possibility that the money could be used to fund abortions.

The liberals ruling Washington the past 4 years have failed to address out-of-control mandatory or discretionary spending. In fact, under their control, discretionary spending has increased 84 percent in just 2 years.

As I mentioned earlier, discretionary spending is the money Congress decides annually to spend on programs with inherent congressional oversight. Mandatory, or autopilot, spending is the money that is automatically pulled from the Treasury without regular congressional oversight. I'm not sure, Mr. Speaker, when that decision was made for Congress to abrogate its responsibility, but it's a weasel way out. We should be looking at every dollar every year, because that's our responsibility.

Our debt and the liberals' insatiable appetite for perpetual government spending increases are sending America into a tailspin. In response to the complete lack of leadership and fiscal responsibility, House Republicans have been very aggressive in reducing wasteful government overspending, which is the real source of breathtaking budget deficits and private sector unemployment.

Now, Mr. Speaker, I would like to point out a chart that comes, I believe, from the Joint Committee on Economics, and it shows what happens when you increase government spending and when you decrease government spending when you're talking about private sector job creation. Every dollar the government takes from the private sector is one less dollar to be spent for private sector innovation and job growth. The government can create only government jobs.

In addition, Mr. Speaker, to the 13.5 million Americans counted in the official unemployment rate, more than 900,000 Americans have stopped looking for a job because they think no jobs exist for them. I want to point out here that, again, when we saw increased government spending, you see a decrease in private sector jobs. When you see decreased government spending, you see an increase in private sector jobs. That's what the Republicans want to do. Americans want jobs. They want to work. We need to cut government spending and allow the private sector to grow.

More than 45 percent of Americans seeking work have been unemployed for more than 27 weeks. Real problems demand real solutions, Mr. Speaker. The track record in the House in 3 short months demonstrates that the new House Republican majority has heard the American people and is acting to provide the relief and solutions they deserve. Less government spending is crucial to encouraging private sector job creation and reducing unemployment. And where better to cut possible government spending than where money could be used for abortions?

With that, Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I just want to point out again that Republicans would like to see more preventive care. However, the example that my colleague from California used says nothing about this bill because there is nothing in here to guarantee that this money will go to preventive care, absolutely nothing. There is no accountability in this legislation.

With that, Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I continue to reserve the balance of my time.

Mr. Speaker, I yield myself the balance of my time.

I would just like to say in response to my colleague from Florida that I think this rule and the underlying bill have a lot more to do with elective abortions than they do with government contracting.

Mr. Speaker, we have discussed at great length today why Secretary Sebelius does not need a slush fund set on autopilot. The American people expect their elected representatives to be wise guardians of their hard-earned dollars. They vehemently objected to the ruling Democrat agenda of Federal overreach into their daily lives and sent a clear message to Washington last November: Government must be responsible and accountable.

All across America, American families are tightening their belts, cutting their budgets and living within their means. It's time Washington did the same.

For these reasons and many more, I urge my colleagues, I urge my colleagues to vote for this rule and the underlying bill so we can restore congressional spending oversight and save the taxpayers $16 billion over the next 10 years.

The material previously referred to by Mr. Hastings of Florida is as follows:

An Amendment to H. Res. 219 Offered by Mr. Hastings of Florida

At the end of the resolution, add the following new

sections:

Sec. 2. Immediately upon adoption of this resolution the

Speaker shall, pursuant to clause 2(b) of rule XVIII, declare

the House resolved into the Committee of the Whole House on

the state of the Union for consideration of the bill (H.R.

1354) to amend titles 10 and 41, United States Code, to allow

contracting officers to consider information regarding

domestic employment before awarding a Federal contract, and

for other purposes. The first reading of the bill shall be

dispensed with. All points of order against consideration of

the bill are waived. General debate shall be confined to the

bill and shall not exceed one hour equally divided and

controlled by the chair and ranking minority member of the

Committee on Oversight and Government Reform. After general

debate the bill shall be considered for amendment under the

five-minute rule. All points of order against provisions in

the bill are waived. At the conclusion of consideration of

the bill for amendment the Committee shall rise and report

the bill to the House with such amendments as may have been

adopted. The previous question shall be considered as ordered

on the bill and amendments thereto to final passage without

intervening motion except one motion to recommit with or

without instructions. If the Committee of the Whole rises and

reports that it has come to no resolution on the bill, then

on the next legislative day the House shall, immediately

after the third daily order of business under clause 1 of

rule XIV, resolve into the Committee of the Whole for further

consideration of the bill.

Sec. 3. Clause 1(c) of rule XIX shall not apply to the

consideration of the bill specified in section 2 of this

resolution.

Mr. Speaker, I yield back the balance of my time, and I move the previous question on the resolution.

Mr. Speaker, on that I demand the yeas and nays.

Let me thank the distinguished gentleman from New Jersey and let me thank the chairman of the committee as well.

Madam Chairwoman, we just have a disagreement. I would venture to say that the bulk of sick people in America and others who every day struggle to maintain their health so they can provide for their families would vigorously disagree as well.

I think there are two points that I would like to make, and that is that what we lose when we repeal this Affordable Care Act and the funding of it is more than the glory that we get from going home and bragging that we have undermined America's health care system, or some would say that we have taken away ObamaCare. Preventative care is an unbelievable plus that this bill has generated.

I went to one of my emergency centers, a new one, that is crafted under the public health system. It is to take the load off the emergency centers, the emergency centers that ambulances go to. What an amazing sight, of people coming with broken toes and fingers and feet and bruises, maybe the beginning of heart disease and other problems. But it was a lower level emergency room, not particularly preventative care but the kind of intervention that can save millions of dollars.

I want to go even lower than that--and I don't use that terminology-- but I want people to be able to go and check on their cholesterol, check on their high blood pressure, understand whether they have sickle cell, understand what stage of diabetes they are in or understand what stage of heart disease they are in in a preventative care cycle. And everyone knows that economists document how many billions of dollar that will save. How can we vote against that?

And then secondarily, there are two elements that the Affordable Care Act provides that is being repealed; research and training for health professionals that we absolutely need--whether you're in the private care system or not--and then of course protecting our most precious resource, and that is our children. If you can raise a

child in a healthy manner in terms of nutrition, in terms of immunization, in terms of regular doctor visits, then you are able to save billions of dollars.

This is wrong, headed in a wrong direction. Many of us are fasting. I said on this floor, we must pray because this is the wrong direction to go.

Madam Chair, I rise today in opposition to H.R. 1217, which would repeal the provision of the Patient Protection and Affordable Care Act (``Affordable Care Act'') that established the Prevention and Public Health Fund, a fund which serves as a great stride toward turning our ``sick-care'' system, where we focus on treating the injured and ill, into a true ``healthcare'' system that puts focus on keeping the population well.

It is because of all that the Prevention and Public Heath Fund accomplished in its first year, the overwhelming support the Fund has received from hundreds of organizations, and how essential prevention is to reducing the overall cost of healthcare for the American people, that I oppose the repeal of this Fund.

Despite my general opposition to this bill, yesterday in the Rules Committee meeting, I offered amendments to H.R. 1217, in order to remind this chamber and emphasize to the American people the importance and benefits of preventative care for the American public.

My amendments reaffirm to the American people that we as lawmakers understand the importance of preventative care by stating that it is the sense of Congress that prevention of disease and injury is overwhelmingly effective in improving our healthcare system and keeping that system affordable. Furthermore, preventative health care is an effective means for detecting and treating illnesses before they become serious and life threatening.

My amendments also make us as lawmakers accountable to the American people who have been and would be benefitting from the services and support provided through this fund. It gives notice to the public, through the Department of Health and Human Services' website, of the rescission of funds and the amount rescinded, increasing government's accountability.

I think most of my colleagues on both sides of the aisle would agree with me, as evidenced by the intense debate at the end of last week, when I say that we must address our nation's spending and growing deficit. However, it is of great concern to me that my friends on the other side of the aisle are attempting to do so by cutting cost-saving programs that are also essential to the health and wellbeing of Americans. This attempt, through H.R. 1217, to defund this essential program which was created under the Patient Protection and Affordable Care Act is of particular concern.

Today's youth may be the first generation to live shorter and less healthy lives than that of their parents, and this is largely due to increased rates of diseases and conditions which are preventable with proper and consistent healthcare. 75% of our country's healthcare costs are attributed to treatment of chronic diseases, most of which are preventable. However, less than 5% of our healthcare

spending goes towards preventing these diseases. Loss of productivity in the workforce attributed to chronic disease is estimated to cost the United States over $1 trillion each year.

With that being said, the 111th Congress, with the intent of seeing these grim statistics changes, appropriated $16.5 billion to be used, over the next ten years to support preventative care and research. Since its establishment the Fund has already begun to strengthen the infrastructure of our healthcare system on the state and national level.

The Prevention and Public Health fund, though it has only been in existence for one year, has already been used for:

Programs to promote tobacco control and implement tobacco cessation services and campaigns;

Obesity prevention which directly decreases risk for Diabetes;

Improving nutrition and access to fresh fruits and vegetables;

Increasing opportunities for recreational and physical activity;

HIV prevention;

Support of clinical and community-based disease prevention; and

Bolstering the health workforce by increasing health care personnel.

Money towards finding health solutions, rather than treating health problems, comes back to society in terms of increasing productivity, creating jobs, and reducing Medicare, Medicaid, and overall healthcare costs. With just a $10 per person investment towards improving community based activity, nutrition, and other preventative measures would create a return of $56 per person within only 5 years. That translates to a savings of $5.60 for every $1 invested in preventative health care. Most importantly, cost benefits extend beyond government to both American businesses and families; providing savings and an improved quality of life.

As a result of the Prevention and Public Health Fund, Texas received $6 million last year that went towards creating committees, testing facilities, laboratories, and training centers which brought over $2 million to the health prevention capacity of Houston alone.

Congress must maintain that the prevention of illness, the saving of lives, and the securing of a healthy public are top priorities, and that prevention is an undeniably effective means to achieve these ends. My amendments will do just that.

The total loss of $16 billion of funding for prevention efforts, an effective total eradication of our country's prevention program, will be unfortunate, and thus I urge my colleagues not to lose sight of importance of the Prevention and Public Health Fund's accomplishments and goals. Including:

The improvement of state and local health departments, giving them the capacity to respond to infections, natural disasters, and terrorist threats;

Creating a strong and healthy workforce that will be competitive in the global market; and

Saving families, businesses, and the government money, opposed to simply cutting costs.

While I do not support what H.R. 1217 purports to do, I urge my colleagues to join me in support of these essential changes to H.R. 1217 to acknowledge the need for preventative care and hold ourselves accountable for what would most certainly be a great loss to the public.

I have an amendment at the desk.

Madam Chair, I know sometimes in the rush of legislating, many Members are faced with any number of challenges in understanding legislation, but I do know that the majority has come with their own roadmap. And I do want to respect the different viewpoints, and I don't say this in any way to malign.

First of all, I'm grateful that this amendment was made in order, but I wish it wasn't because I understand that all legislation that passes needs to have in fact--or often has those who agree with it and those who do not. And that's fair enough.

And the process that we usually use to handle that is to amend, not repeal. There are some sections here that I have looked at and have concern with. And many have heard me on the floor of the House discussing a number of issues regarding my local hospitals. But I will say to you that the repeal of this bill is putting us on the road to ruin.

And my amendment is simple. It asks the HHS to place on its Web site the moneys rescinded so that the American people can see. For some it may be to see the great success of taking away money. For others, it may be to see what has happened to the resources that they need to take care of themselves.

Very quickly, this amendment requires for fiscal years 2010, 2011, 2012, 2013, 2014 to list the amount of money that is being taken away from good health care. But, Madam Chair, it will also hopefully point people to what they're losing.

For example, look at this beautiful baby here. We will not have, under the repeal of this Affordable Care Act, the bounty of preventative care. For those with chronic diseases, Americans who are subject to chronic disease such as heart disease, cancer, stroke and diabetes, their only care will be the emergency room, high-priced emergency room when they're in a diabetic coma or they're in a stroke or they have a heart attack, rather than be able to go to their doctors.

But we start early on with this little baby being able to go to wellness clinics or to their community health clinics. That's what the money that is being rescinded is going to do to you.

In addition, you will find that chronic diseases resulted in $75.3 billion loss in productivity in the State of Texas alone. This is going to be across America.

The rescissions will also impact all of the States. I have a list of almost 50 States that have begun to receive dollars from the Affordable Care Act--from Alabama, to Alaska, to Pennsylvania, to Massachusetts, to Michigan, to Rhode Island, and South Carolina, and Tennessee, and Texas. All of the States that my good friends come from, they are receiving money right now.

In addition to this issue of taking away money, Prevention for Healthy America concluded that investing $10 per person per year in proven community-based programs that increased physical activity, for example, improved nutrition, and prevents smoking and other tobacco could save the country more than $16 billion annually within 5 years.

When you see how much money was taken away, just realize that you multiply that. If it's a total of $16 billion, you're going to lose $16 billion a year because there will not be any wellness program. Community and clinical prevention, which is about $2 million. And so you will take away money from HIV

prevention, and that is a very costly proposal.

You'll take away from public health infrastructure; you'll take away from primary care residential expansion programs training residents and doctors. You'll take away from other medical assistance programs, expansion of physician assistant training. You'll take away from public health departments where they link people to needed health care. You'll take away childhood and adult immunizations and protecting the water we drink and the food we eat.

Let me just say to you that my amendment is to shine the light on what will be happening to the health care of Americans. I want my colleagues to tell their constituents, not those that are already focused on negative aspects of what we're trying to do here, but those who are just simply hardworking mothers and fathers who are trying to make a living and who need this health care.

Madam Chair, I would first like to state my clear position that I am adamantly opposed to H.R. 1217 and its repeal of the important Prevention and Public Health Fund created under the Affordable Care Act. The Fund saves lives and saves money.

If H.R. 1217 to repeal the Prevention and Public Health Fund provided under section 4002 of the Patient Protection and Affordable Care Act is enacted into law:

What my amendment does is: Requires the Department of Health and Human Services to post public notice on its official website of the Unobligated Funds from section 4002 of the Patient Protection and Affordable Care Act including the amount of the funds that will be rescinded.

This amendment will provide the public with important information about Preventive Health Care funding that will no longer be available for them to receive necessary preventive health care services.

This amendment also assists my Republican colleagues by permitting them to easily show the American public that they are cutting government spending, by how much they are cutting spending, and where they are cutting government spending. So I expect that my Republican colleagues will fully support this amendment.

Purpose of the Prevention and Public Health Fund (Section 4002 of the

Affordable Care Act)

When Congress passed the Affordable Care Act in 2010 and the President signed it into law, the Department of Health of Human Services was given the power to administer the program to provide for expanded and sustained national health investment in prevention and public health programs to improve public health programs and help restrain the growth in private and public health costs. This was already a cost cutting measure.

Nearly 11.7 million cases of seven common chronic diseases--cancers, diabetes, heart disease, hypertension, stroke, mental disorders, and pulmonary conditions--were reported in Texas in 2003.

The cost of treating those with chronic disease in Texas totaled about $17.2 billion.

Chronic diseases resulted in $75.3 billion in lost productivity and economic costs to Texas.

A new focus on prevention will offer Texas and the rest of our nation the opportunity to not only improve the health of Americans, but also control health care spending. A report from Trust for America's Health entitled Prevention for a Healthier America concluded that investing $10 per person per year in proven community-based programs that increase physical activity, improve nutrition, and prevent smoking and other tobacco use could save the country more than $16 billion annually within 5 years. This is a return of $5.60 for every $1 spent on preventive health care.

How the Fund Improves Wellness and Prevention for Texans

Since enactment of the Affordable Care Act on March 23, 2010, the Department of Health and Human Services has awarded approximately $17.63 million in grants to organizations in Texas through the Prevention and Public Health Fund to help improve wellness and prevention efforts, including:

Community and Clinical Prevention ($2,956,000): This funding supports prevention activities that have been shown to be effective in reducing health care costs and promoting health and wellness.

Primary and Behavioral Health Integration ($495,000). Assists communities with the integration of primary care services into community-based mental & behavioral health settings.

HIV Prevention ($2,359,000). Focuses on HIV prevention in high risk populations and communities by increasing HIV testing opportunities, linking HIV-infected persons with appropriate services, and filling critical gaps in data and understanding of the HIV epidemic.

Tobacco Cessation ($102,000). Strengthens Texas's ability to move towards implementing a plan to reduce tobacco use. It also enhances and expands the national network of tobacco cessation quitlines to significantly increase the number of tobacco users who quit each year.

Public Health Infrastructure ($2,084,000): These grants strengthen state and local capacity to prepare health departments to meet 21st century public health challenges and support the training of existing and next generation public health professionals.

Public Health Infrastructure ($800,000). Supports state, local, and tribal public health infrastructure to improve information technology, workforce training, and policy development.

Epidemiology and Laboratory Capacity ($634,000). Builds state and local capacity to prevent, detect, and respond to infectious disease outbreaks.

Public Health Training Centers ($650,000). Improve the public health system by enhancing skills of the current and future public health workforce.

Primary Care Training ($12,586,000): These funds support the expansion of the primary care workforce.

Primary Care Residency Expansion Program ($7,680,000). Increases the number of residents trained in family medicine, general internal medicine, and general pediatrics.

Advanced Nursing Education Expansion Program ($1,426,000). Increases the number of primary care nurse practitioners and nurse midwives who graduate by expanding class sizes and accelerating graduation rates for part-time students.

Expansion of Physician Assistant Training ($1,980,000). Improves access to primary care by funding the training of primary care physician assistants and expanding the primary care workforce.

Nurse-Managed Health Clinics ($1,500,000). Provide primary care and wellness services to underserved and vulnerable populations through clinics that are managed by advanced practice nurses and provide valuable clinical training sites for primary care nurse practitioners.

If the Prevention and Public Health Fund is cut and its Unobligated Funds Rescinded our health care costs will soar and the results will be catastrophic. The Fund saves lives and saves money.

if the funds are rescinded

America's local health departments need the Prevention and Public Health Fund to help prevent diseases and protect health in ways that health insurance companies or medical care providers cannot.

Local health departments:

Link people who need healthcare with ways to get it.

Detect and stop outbreaks of disease.

Help people make healthier choices in diet, exercise, and tobacco use to prevent and reduce chronic disease.

Provide childhood and adult immunizations.

Protect the water we drink and the food we eat.

Help new parents give babies a healthy start at home.

Inspect schools and day care centers for health and safety.

Conduct screenings for cancer, heart disease, diabetes, childhood lead poisoning, tuberculosis, and other infectious diseases.

The Prevention and Public Health Fund is critically needed to stabilize the ability of local health departments to protect their communities from health threats and help individuals and families lead productive and healthy lives. Please oppose this attempt by H.R. 1217 to eliminate funding for the Prevention and Public Health Fund. A healthy future depends on it.

If H.R. 1217 passes this Chamber and is enacted into law, it is important for the American People to have notice of the rescission of funds for the Prevention and Public Health Fund program. Since the Department of Health and Human Services administers the Fund, it is only appropriate that public notice be given on the official HHS website and include the amount of funds rescinded. In this way, the American public will know that the public funding they rely upon has been cancelled for preventive health care and the Transparency of Spending Cuts will be further promoted in a manner that my Republican Colleagues will also appreciate.

I would urge all Members of Congress to support my amendment.

I yield back the balance of my time.

Mr. Chairman, I would just remind the gentleman, the ranking member from New Jersey, in our committee hearing earlier this year we heard from the Governor of Utah who had been setting up a state exchange prior to the passage of the Patient Protection and Affordable Care Act, and now was left with an uncomfortable situation where it has been ruled unconstitutional by two district courts. He's waiting for whatever happens in the court system. But as he told us in committee, ``I'm walking on shifting sands. I no longer know where to go. Passage of the Patient Protection and Affordable Care Act has made my life infinitely harder.''

I would now yield 2 minutes to the gentleman from New Jersey (Mr. Lance).

Mr. Chairman, I yield 2 minutes to the subcommittee chairman of the Oversight and Investigations Subcommittee, the gentleman from Florida (Mr. Stearns).

(Mr. STEARNS asked and was given permission to revise and extend his remarks.)

Mr. Chairman, I yield 2 minutes to the gentlelady from Tennessee (Mrs. Blackburn).

Mr. Chairman, I yield 2 minutes to a valuable member of the committee, the gentleman from Kansas (Mr. Pompeo).

(Mr. POMPEO asked and was given permission to revise and extend his remarks.)

Mr. Chairman, I would just point out that this bill only rescinds monies that have not been obligated. Monies that have been obligated would not be rescinded.

I now yield 2 minutes to the gentleman from Iowa, Steve King.

I yield the gentleman an additional 30 seconds.

Mr. Chairman, I yield myself 1 minute.

How many times did we hear over the runup to the passage of the Patient Protection and Affordable Care Act, If you like what you have, you can keep it? It turns out nothing could be further from the truth. In fact, the real truth is they don't want you to keep your current insurance.

We have heard Members on the other side of the aisle claim that 2 million fewer people will be enrolled in the exchange and that the bill will increase costs to the employers. So here is some shocking news: These assertions that during the health care debate many people said repeatedly that under the bill you will not be able to keep your health insurance you like, in spite of promises made by the Democrats, people were concerned that the new law would encourage employers to drop health care coverage for workers.

In fact, we received some memos to that effect as part of an investigation that then-Chairman Waxman actually initiated right after the passage of the bill. But then when trying to pass the bill, the Democrats repeatedly denied those claims. Now they seem to relish the fact that employers will drop coverage, and they actually see it as a negative that 1 million people will continue to have employer-sponsored insurance, the coverage that they precisely wanted to keep.

I reserve the balance of my time.

I yield myself 3 minutes.

Mr. Chairman, States are coming to the realization that there is no flexibility in these grants. They are coming to understand that the mere words that a State gets to develop an exchange that fits their individual needs, in fact, just rings hollow.

The other side has used the word ``flexibility'' as a big bait-and- switch, just similar to the words ``if you like what you have, you can keep it.'' The authors of the bill praised these words, but they are simply not true. The law clearly puts Washington in control, in firm control, in absolute control, of these exchanges.

For example, section 1302, the Secretary will choose the essential benefits that must be paid for by individuals and families in the State exchange.

Section 1302 (d)(2), the Secretary will control whether an HSA can be offered.

Section 1311(h), the Secretary can by regulation select the doctors and other health professionals that are allowed to provide care in the exchange plans. As a physician, I find this one of the more chilling provisions in this legislation.

Section 1311(i), the Secretary--the Secretary--decides whether a plan provides linguistically appropriate and culturally sensitive information. If they do not meet the Secretary's approval, they cannot have that plan.

Section 1311(c)(1) and section 1311(e), the Secretary--the Secretary--determines the process and requirements for certifying whether a plan can be sold in the exchange.

Section 1311(c)(1)(I)(6), the Secretary can decide when individuals can enroll in the exchange plan.

Section 1311(d)(4), the Secretary will judge the adequacy of an exchange Internet Web site.

Section 1311(k), the Secretary will determine whether an exchange establishes rules that conflict with or prevent the application of regulations promulgated by the Secretary. In other words, not only do they get to make the rules; they get to be the referee.

Concerns were raised prior to the passage of the Patient Protection Affordable Care Act that the law was designed, designed, for employers to drop coverage so Washington would control health care through ObamaCare exchanges. Now the other side protests when 1 million people will keep their employer-sponsored insurance because they would rather have them under the direct and absolute control of Washington, D.C., rather than their State capitals.

I reserve the balance of my time.

I yield myself 1 minute, Mr. Chairman.

I would remind my colleagues on the other side of the aisle that the Governor of Utah coming to our committee hearing said that he was setting up exchanges prior to the passage of the Patient Protection and Affordable Care Act. The passage of the Patient Protection and Affordable Care Act has limited his ability to provide those exchanges. In fact, he went so far as to say now, with the nebulous future surrounding the Patient Protection and Affordable Care Act, because of activity in the courts--not in the United States House of Representatives, but in the courts--remember them, the third branch of government that gets to decide if something is constitutional or not-- because of the ambiguity surrounding the cases in the courts, the Governor of Utah felt that he could not go forward with the plan that he was implementing, and he worried that the money he had already spent, his own State's money on developing State exchanges, would now be for naught. He does not know what the rules will be going forward if the Patient Protection and Affordable Care Act is allowed to stand because those rules have yet to be written. Those rules have yet to be interpreted.

So in a very perverse way, we have made it harder for a State to provide exchanges by passing the Patient Protection and Affordable Care Act.

I reserve the balance of my time.

I yield myself such time as I may consume.

Mr. Chairman, I would not presume to put words into the mouth of the Governor of Georgia, but I do know from a long association with him that he was very abhorrent of any mandates that were placed on the States. So I do not doubt the fact that he said the worst of all possible worlds would be to get the mandate and not get anything else to help him back that mandate. But to be very clear, the mandates themselves are the anathema.

Why would those mandates be a problem for the Governor of Georgia or the Governor of any other State? Because now the decisionmaking does not rest with the State. The State is mandated. The State is mandated to set up these changes. And yet the Health and Human Services Secretary will choose the essential benefits that must be paid for by individuals and their families.

That's no longer a State decision. That's no longer a gubernatorial directive. That is now a directive from the Secretary of Health and Human Services. They would also decide whether their planned provider network is adequate, regardless of whether or not it covers the doctor that you use and you like. The Secretary--not the Governor, not the Governor's chief of staff, not someone in the State legislature--the Secretary of the Department of Health and Human Services, who has that now unprecedented power and is only limited by her own imagination.

The Secretary would impose price controls on health coverage. The Secretary would pick who gets a waiver from the annual limit requirements. The Secretary would establish cost-sharing requirements regardless of their effects on premiums, not a gubernatorial directive, not something established by the State Commission of Insurance, not something contributed to by the Governor's chief of staff, not something decided by any State legislature, but by the Secretary of the Department of Health and Human Service.

Again, Chairman Upton in his opening remarks said the spending would only be limited by the imagination, by the limits of the imagination of the Secretary of the Department of Health and Human Services. We know who that is this year. We don't know who that is next year. We certainly do not know who that is in 2 years' time.

It is the responsibility of this Congress to exercise the due oversight over these programs. We abnegated that authority by the forward funding of these programs. As Mr. King pointed out in his remarks, we abnegated that authority. It's now time for Congress to claim that back. That's not mindless. The mindlessness, I might remind the Chair, was when this bill was passed a year ago without due proper authorization and oversight.

I reserve the balance of my time.

Mr. Chairman, I will direct my remarks to the Chair and not to anyone in particular, which I believe is one of the habits of the House; and I yield myself 1 minute for this purpose.

I was always taught growing up that if you're going to tell a story, you ought to begin it with ``once upon a time.'' I think I should have heard a few ``once upon a times'' in that last tirade that was just leveled upon the House.

Their hypocrisy knows no bounds, Mr. Chairman. The other side claims that the health care law is about State flexibility, but they oppose H.R. 1213 because some States might assess a health plan fee to fund the operation of exchanges that the State wants to set up. If you're for flexibility, then eliminate complete control that the Secretary has over the State exchanges. Let States establish exchanges without onerous and costly Federal mandates and finance them according to how each State feels is appropriate.

Now, to talk about hypocrisy, what the other side fails to mention is that the Patient Protection and Affordable Care Act advocates taxing health care plans that sell insurance in the exchanges. Rather than being silent on how States should fund their exchanges once the grant money runs out, the Democrat health care bill actually spells out that the States should consider charging taxes on health insurance premiums for plans sold in the exchange.

I yield myself an additional 30 seconds.

The hypocrisy could be tolerable if it just simply ended there. However, the other side also fails to mention that the Patient Protection and Affordable Care Act directly charges a $60 billion tax on Americans' health insurance premiums, in section 9010, or that imposes tens of billions of dollars in direct taxes on medical devices and drugs that people will use that will increase their health care premiums, according to the CMS actuary.

I reserve the balance of my time.

Mr. Chairman, I yield myself 1 minute.

Although the issue of Medicare is not the subject of this debate today, I can recall a time about 20 years ago when Paul Tsongas, a former Senator, came to Dallas to talk to a group called the Dallas Business Group on Health. It was the day after President Clinton had come to this House and addressed a joint session of the House and Senate and unveiled his health care plan in September of 1993. Senator Tsongas came to talk to us in Dallas, and he said, ``It was a beautiful speech. There wasn't a dry eye in the house. The only problem was that the President proposed five new entitlement programs, and we cannot pay for the ones that we have.''

Former Senator Tsongas then went on to articulate how the rate of rise of entitlement spending was going to cripple this country in the future such that by at some point between 2015 and 2020 this country would see intergenerational conflict the likes of which it had never seen before.

Yes, it is incumbent upon us to recognize that train wreck that is coming and deal with it. Representative Ryan put forward a very thoughtful plan 2 weeks ago. Let's see the plan from the other side. So far that's been lacking.

I reserve the balance of my time.

Mr. Chairman, at this point, I would like to yield 4 minutes to the chairman emeritus of the full committee, the gentleman from Texas (Mr. Barton).

(Mr. BARTON of Texas asked and was given permission to revise and extend his remarks.)

I urge an ``aye'' vote on the measure.

I yield back the balance of my time.

Mr. Chairman, I rise in opposition to the amendment.

I supported a seemingly similar amendment 3 weeks ago when the House considered H.R. 1217, a bill related to the public health slush fund in the Patient Protection and Affordable Care Act. However, I have to oppose this amendment because, despite the seeming similarity of the two amendments, this really is an apples-to-oranges comparison. The public health slush fund considered under H.R. 1217 provided a specified amount in mandatory funding for the Secretary in fiscal year 2011 and each year thereafter. In Ms. Jackson Lee's amendment 3 weeks ago, it would be possible to determine the amount of funds that would be rescinded in fiscal year 2011 if H.R. 1217 had been enacted into law. But the amendment offered today by Ms. Jackson Lee actually strengthens the arguments in favor of passing H.R. 1213, the bill before us today.

Section 1311 of the Patient Protection and Affordable Care Act provided the Secretary with an unlimited amount of money with virtually limitless discretion to spend on establishing exchanges or what activities could facilitate enrollment in what are known as qualified health plans. Giving the Secretary a blank check to spend is an abdication of our responsibility here in the House of Representatives. This blank check also makes it impossible to implement the Jackson Lee amendment. There is no dollar figure for how much the Secretary can spend on this program. It is simply an unknown unknown. The Secretary could decide tomorrow to spend another $100 million or another $100 billion. In 2013 the Secretary could take the advice of CMS and funnel money into any amount of activities. Congress and, for that matter, the general public won't know that until the money is spent.

I think the gentlelady from Texas has good intentions with her amendment. Unfortunately, because Congress decided to leave it entirely up to the Secretary of Health and Human Services and the Secretary alone to determine the amounts of money that can be spent, the amendment does not work in this circumstance. I urge my colleagues to oppose the amendment.

Again, I would just simply point out that the gentlelady's amendment under the legislation that was considered previously was appropriate because there were actually funding levels that were mentioned in the legislation.

Now, reading from the Patient Protection and Affordable Care Act here in section 4002, under the Prevention and Public Health Fund, in paragraph B, which discusses funding: There are hereby authorized to be appropriated and appropriated to the fund out of any moneys in the Treasury not otherwise appropriated, one, for fiscal year 2010 $500 million; two, for fiscal year 2011 $750,000, and so on and so forth. In other words, the funding is explicit under the previously considered legislation.

Under the legislation today, which is the health benefits exchange, here is how the funding language reads: For each fiscal year, the Secretary shall determine the total amount that the Secretary will make available for each State for grants under this subsection. Well, we have no earthly idea. Is that $10, $100, $100 million, $100 billion, $13 trillion? We have no earthly idea.

So while the intent of this amendment in previous legislation was one which the majority could accept, in this case, it actually becomes meaningless because there is no dollar figure

specified as the upper limit as to what the Secretary can spend.

I reserve the balance of my time.

I yield myself 3 minutes.

Mr. Chairman, this is just another in the Republican series of efforts to try to repeal the Affordable Care Act. I don't need to say, but I will say over and over again how effective the Affordable Care Act has been.

We have already put in place most of the anti-discriminatory aspects of the Affordable Care Act so that people now can have their children up to 26 on their insurance policy. They don't have lifetime or annual limits on care. We've ended arbitrary rescissions. We're giving patients access to preventive services without cost. We've begun the process of filling up the doughnut hole by giving seniors a $250 rebate last year, and now a 50 percent discount on the drugs. The list goes on and on. People are starting to see the benefits of the Affordable Care Act.

But as you know, over the next few years, until 2014, one of the major benefits of it is that we will now cover almost every American; 32 more million Americans that have no insurance now, with a guaranteed good benefits package, lower costs, and help in paying their premiums.

The fact of the matter is, the Republicans want to eliminate all this. And when they talk today about bringing up a bill that would eliminate the grants or the funding for the state exchanges, this is at the core of the Affordable Care Act because, without effective state exchanges, robust state exchanges that are actually tailored, if you will, to individual States, it will be more difficult to do the things that I mentioned that are the commitment and the promise of the Affordable Care Act.

Now, what I don't understand though is that my colleagues on the other side of the aisle have always been advocates for States' rights. The consequence of their legislation today if it were to become law would mean that States, and 49 States and most of the territories have asked for these grants, would be denied these grants to set up the State exchanges. Most likely, what will happen then is that, rather than have a State exchange which is tailored to their own State and their own constituents, they will end up having a Federal or national exchange.

Now frankly, I don't have a problem with that. But if you're a States rights advocate, which is what a lot of the Republicans have been saying all along, why would you want to force the States to not have their own flexibility, not set up their own State exchanges and instead set up a Federal exchange?

The exchanges aren't going to go away with this legislation. It's simply going to mean that the States can't do a good job, or that they're going to yield that power to the Federal Government and you're going to have a national exchange.

This is the worst time to do this. As we know, States are hurting. They don't have money. Most of them have a crisis in terms of balancing their budget. Why would you want to deny them the money to set up the exchange?

I'll give you an example in my own State. My own State has applied for some of these grants. They are using it to do demographics to find out what kind of people they have, what their health care needs are, so they can tailor the State exchange in a way that's most effective to cover the most Americans and provide them good quality health care at a low cost. That's what this is all about.

And for the Republicans today to bring this bill up in their effort to try to repeal the whole package, it absolutely makes no sense whatsoever. I just don't understand it.

They talk about mandatory funding. Well, we have mandatory funding for Medicare, for Medicaid, for all kind of things in this Congress. All they're going to do with this is make it more difficult for the States to establish their own exchange.

I reserve the balance of my time.

Mr. Chairman, I yield 4 minutes to the ranking member of our full Energy and Commerce Committee, the gentleman from California (Mr. Waxman).

I now yield 1\1/2\ minutes to the gentleman from New York (Mr. Engel).

Mr. Chairman, I yield myself 15 seconds.

I hold the gentlewoman in a lot of respect, but it bothers me that you say we are going to come back and keep voting and voting again on repeal, repeal, repeal. We know this isn't going to pass the Senate.

When I went home the last 2 weeks, all I heard was: What are you doing to create jobs? Deal with the economy.

When we deal with this and keep doing the same thing over and over again, we don't deal with jobs.

I yield now 1\1/2\ minutes to the gentlewoman from California (Mrs. Capps).

Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman from Wisconsin (Ms. Baldwin).

Mr. Chairman, I yield myself 30 seconds.

I would just like to point out to the gentleman, 49 States and the District of Columbia, along with 4 territories, have been awarded $54 million in planning grants. So all you are doing here--these exchanges are still going to exist even if this bill passed and became law. All you are doing is taking away the money, in almost every case, from your own State to try to set up these exchanges and not have it become a national exchange.

So the gentleman can talk all he wants about the funding, but the fact of the matter is it is most likely his own State is asking for this funding so they can get these exchanges established. Why do the Republicans want to take money away from their own State?

I yield now 1\1/2\ minutes to the gentlewoman from the Virgin Islands (Mrs. Christensen).

Mr. Chairman, can I inquire how much time remains on both sides?

I yield now 2 minutes to the gentleman from Texas (Mr. Green).

Mr. Chairman, I yield myself 30 seconds.

Again, I don't understand what Dr. Burgess is trying to say, the point he is trying to make. If we don't have this funding under this bill, States are not going to be able to choose the type of marketplace that is best for their families and businesses. By passing this bill, you take away ultimately the States' right to make the decisions about what kind of plans they have and how they want to tailor these plans.

All he is doing with this bill is handing it over to the Federal Government, exactly the opposite of what he is saying. What he is reading is essentially what is going to happen if there is no State exchange and there is a Federal exchange. So why deny the States the money, when they can tailor the exchange with those grants?

I yield now 2 minutes to the gentlewoman from Connecticut (Ms. DeLauro), the ranking member on the Labor-HHS appropriations subcommittee.

Mr. Chairman, I yield myself 1 minute.

I have heard Dr. Burgess talk about Governors. I just want to give you some quotes from some Governors--Republican Governors. Nathan Deal, a former member of the Energy and Commerce Committee, former chairman of the Health Subcommittee, this is what he said with regard to the State exchanges and the grants. He says: ``One of the real problems that some of us as Governors foresee is if the mandates on States remain in place, the funding from the Federal level to carry out those mandates is withheld. That's the worst possible condition that States could be left in.''

That is exactly what my colleague from Texas is proposing. The States will continue to have the mandate to set up the exchange or, without money and therefore not be able to tailor to exchange to the State or alternatively letting it go to the Federal Government, having the Federal Government run a Federal exchange.

Nathan Deal, one of our own Members, chairman of the subcommittee, said, Worst possible scenario. I don't understand. Again, I keep saying the same thing, but I have to repeat it, Mr. Chairman. To say that we're going to have State exchanges without having

the funding means the State exchange will either be lousy, or it simply won't exist and the Federal Government takes over.

I yield now 2 minutes to the gentleman from Michigan (Mr. Levin), the ranking member on the Ways and Means Committee.

(Mr. LEVIN asked and was given permission to revise and extend his remarks.)

Mr. Chairman, I yield myself 1 minute.

Again, I listened to the gentlewoman from Tennessee (Mrs. Blackburn) before, and basically she said we're just going to keep repealing and repealing and repealing. I understand that you want to get rid of the whole bill. But why do you bring up legislation today that, again, I guess you're doing it because you don't want to keep repealing the whole bill over and over again because it becomes ludicrous. So instead you take pieces out--in this case, the State exchanges--and you say we're not going to give States the grants to actually follow up.

It's obvious, when we talked about Nathan Deal, he doesn't like the law. He'd like to see it repealed. But he's saying if you're not going to repeal it, then don't defund it because then the States can't carry out their functions in an effective way.

So all I'm saying to my colleague from Texas is if you just want to keep repealing and repealing, like Mrs. Blackburn said, go ahead and do it. We'll waste time, which doesn't make sense. But if you're going to then take pieces out, then don't say to the States, We're going to defund you and not allow you to do what you're already required to do or set this over to the Federal Government.

You see, this is the absurdity of what the other side of the aisle is trying to do. It's just a complete waste of time.

I yield now 2 minutes to the gentleman from California (Mr. Miller).

I yield the gentleman an additional 30 seconds.

Mr. Chairman, I yield 3 minutes to the gentleman from California (Mr. Garamendi).

Mr. Chairman, may I inquire how much time is remaining?

I yield myself the balance of my time.

Mr. Chairman, I am pleased that my colleague on the other side, Dr. Burgess, got up and talked about the Ryan budget, or the Republican budget, I should say, because as far as I know every Republican voted for it, and most Democrats voted against it, and he also mentioned, I think, President Clinton's efforts to achieve health care reform.

The Democrats over the years--Harry Truman, President Clinton, President Obama--have all been reaching out to try to achieve health care reform and find a low-cost way of providing a good benefit package to all Americans, and it's sad to think that on the other side of the aisle, when they became the majority, the first thing they did was to pass this Republican budget that actually puts an end to Medicare and really jeopardizes the future of Medicaid as well.

I think it says a lot about the fact that the Democrats are trying to expand health care choices and options

and provide low-cost health care with a good benefit package. The Republicans are taking the plans that exist now like Medicare and Medicaid and either ending them in the case of Medicare or in the case of Medicaid really making it so it's going to be very difficult for Medicaid to continue.

We already have in place, as I mentioned in the beginning of this debate, many of the positive aspects of the Affordable Care Act, all those things that eliminate discrimination, let you put your children on your policy, start to plug up the donut hole for prescription drugs for seniors. This is working. This is legislation that's working and making a difference for the American people and making it possible now with these State exchanges, once they're up and running with the tax credits that are available, for even those other 32 or 30 to 40 million Americans who don't have health insurance insurance now to finally have it.

Now, why do the Republicans want to eliminate this? I listened to Dr. Burgess. He says it costs too much. The fact of the matter is the CBO said the Affordable Care Act was going to save money, reduce the deficit over 10 years. I know they only like to look at the CBO numbers when they think they're beneficial to their point of view, but the fact of the matter is the CBO is a nonpartisan arm of this Congress and they say that the Affordable Care Act reduces the deficit over 10 years. At the same time, we're covering everyone and we're providing a good benefit package just like, say, Blue Cross or Blue Shield does today.

What this bill does is to eliminate choices, because if the States are allowed to tailor a program in exchange for their own constituents in their State, I believe it will be more robust, it will be a better plan tailored to those people from New Jersey, in my case, or Texas, in the case of Dr. Burgess. By taking away the money for the exchanges, all you're going to do is make that more and more difficult. States will still have to do it, but they won't have a good plan. They may limit their choices. They may not have a lot of choices which they would have if they have some money to plan and be rational about how this works.

Of course, the more likely scenario is that we will simply have a Federal exchange and a lot of States will opt out and not even have their own State exchange. I think that would be a mistake to do. I really do. As much as I'd rather have a Federal exchange than no exchange, I do think it makes sense to have State exchanges.

So, again, I think that what the Republicans are doing now, and I think that Mrs. Blackburn said it earlier--she said we're just going to repeal this, and we're going to take a piece of it and repeal something else until we get rid of the whole thing. Well, don't waste the time of the Congress on doing the same thing over and over again. I was home for the last 2 weeks. We all had a break. We're at home for 2 weeks. All I heard, I didn't hear about health care. I heard about jobs and how the economy was starting to sputter again.

You know, the last quarter was not as good as it could have been, and the fact of the matter is that since the Republicans have come into the majority here they're not doing anything to create jobs. We don't have a bill to create jobs. We keep doing the same thing every day. Today, it's going to be defund health care; tomorrow it's going to be abortion again. I don't know how many times we're going to have these same bills that come out of our Health Subcommittee and the Energy and Commerce Committee.

It is unfortunate. I urge my colleagues to vote ``no'' on this bill.